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. 2022 Sep;34(9):e14384.
doi: 10.1111/nmo.14384. Epub 2022 Apr 27.

The visceral sensitivity index: A novel tool for measuring GI-symptom-specific anxiety in inflammatory bowel disease

Kimberly Trieschmann  1 , Lin Chang  2 , Sarah Park  2 , Bruce Naliboff  2 , Swapna Joshi  2 , Jennifer S Labus  2 , Jenny S Sauk  3 , Berkeley N Limketkai  3 , Emeran A Mayer  2
Affiliations

The visceral sensitivity index: A novel tool for measuring GI-symptom-specific anxiety in inflammatory bowel disease

Kimberly Trieschmann et al. Neurogastroenterol Motil. 2022 Sep.

Abstract

Background: Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are chronic gastrointestinal (GI) disorders. GI symptom-specific anxiety (GSA) is the cognitive, affective, and behavioral response stemming from fear of GI symptoms. The Visceral Sensitivity Index (VSI) measures GSA and is validated in IBS and may be useful in IBD.

Methods: We compared VSI scores in IBD participants to IBS participants and healthy controls (HCs). Using validated questionnaires, we assessed the VSI's correlation with anxiety, health-related quality of life (HRQOL), and IBD activity.

Key results: We recruited 222 age- and sex-matched participants (74 IBD [23 Crohn's disease; 51 ulcerative colitis], 74 IBS, and 74 HCs). IBD and IBS participants had higher VSI scores compared with HCs (IBD = 26.62 ± 16.64, IBS = 38.83 ± 15.06; HCs = 3.42±5.06; all p's < 0.001). VSI scores were lower in IBD vs IBS (p < 0.001). In IBD, VSI modestly correlated with current anxiety (R = 0.35, p = 0.002) and the physical component of HRQOL (R = -0.45, p = 0.0001) but less with the mental component of HRQOL (R = -0.23, p = 0.05).

Conclusions & inferences: Our findings suggest the VSI is a useful measure in IBD. The VSI in IBD is related to general anxiety but is measuring a different construct and is not affected by the presence of trait anxiety. IBD patients have GSA that is associated with decreased HRQOL, which can negatively affect treatment compliance and other long-term disease outcomes. Future studies are needed to further validate the VSI in IBD and to assess its correlation with disease activity.

Keywords: anxiety; inflammatory bowel diseases; irritable bowel syndrome; quality of life; severity of illness index.

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Conflict of interest statement

CONFLICT OF INTEREST/DISCLOSURES STATEMENT: To the best of our knowledge, the named authors have no conflict of interest, financial or otherwise.

Figures

Figure 1:
Figure 1:
VSI scores were higher in in ulcerative colitis (UC, n=51, p<0.001), Crohn’s disease (CD, n=23, p<0.001), and Irritable Bowel Syndrome (IBS, n=74, p<0.001) compared to healthy controls (HC), n=74). VSI scores were similar between CD and UC (p=0.59). VSI scores were higher in IBS compared to IBD (p<0.001).
Figure 2:
Figure 2:
In adult participants with inflammatory bowel disease, visceral sensitivity index (VSI) scores modestly correlated with general anxiety as measured by the Hospital Anxiety and Depression Scale (HAD) – Anxiety subscale (R=0.35, P=0.002).
Figure 3:
Figure 3:
In adult participants with inflammatory bowel disease, there was a non-significant trend toward positive correlation between visceral sensitivity index (VSI) scores and trait anxiety as measured by the State Trait Anxiety Inventory (STAI) (R=0.22, P=0.06).
Figure 4:
Figure 4:
In adult participants with inflammatory bowel disease, visceral sensitivity index (VSI) scores had a moderate correlation with the physical component of health-related quality of life (HRQOL) (R=−0.45, P=0.0001). The physical component of HRQOL was assessed by the medical outcomes study (MOS) 12-item short form (SF-12) physical composite score (PCS) which is scored 0-100 with 0 being poor health and 100 being highest level of health.
Figure 5:
Figure 5:
In adult participants with inflammatory bowel disease (IBD), visceral sensitivity index (VSI) scores were significantly higher in those with moderate/severe usual GI symptom severity (86.8% of IBD participants) compared those with none/mild usual GI symptom severity (28.3% of IBD participants) as measured by the Bowel Symptom Questionnaire (BSQ) (P=0.008).
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